Integrated pharmacy model improves adherence, reduces costs

An integrated-care model, that features onsite pharmacies within community mental health centers, produces higher medication adherence rates than community pharmacies, according to a new study published in the Journal of Managed Care & Specialty Pharmacy.

The study also shows lower rates of hospitalization and lower emergency department utilization for the patients that visit integrated care pharmacies. In behavioral health, proper medication management has become a cornerstone of treatment.

The integrated-care model provides “real-time” integrated pharmacy services directly within the clinical setting. The pharmacy is connected to the clinic, has a physical presence on site, and works directly with the providers who deliver care to patients. They collaborate with the interdisciplinary treatment team, including prescribers, nurses, and case managers to develop and refine treatment plans for patients.

The study compared data from more than 2,500 consumers of two community mental health centers over a 13-month period to see if there were differences in medication adherence and outcomes between consumers who used integrated-care pharmacy models and those who used community pharmacies. Cost avoidance estimates for integrated-care patients were approximately $58 per member per month based on costs for hospitalizations and emergency department visits for a total estimated savings of $230,000 for the 1,378 integrated-care patients studied during the 13-month period.

The study also found:

• Integrated pharmacy patients had a 96% medication adherence rate which was significantly greater than community pharmacies across all patient groups.

• Integrated pharmacy patients had a 40% lower rate of behavioral health-related hospitalizations.

• Integrated pharmacy patients had an 18% lower rate of behavioral health-related emergency department visits.

Odorzynski“Individuals with mental illness and other complex chronic conditions are a population increasing within the Medicaid managed care and Medicare plans serving populations eligible for both Medicare and Medicaid-including dual special needs plans and MMIPs,” says Bill Guptail, senior vice president, payer relations at Genoa, a QoL Healthcare Company, the setting of the study. “This study demonstrates a ‘best practice’ care delivery model proven to significantly reduce overall cost of care, while improving the quality of care provided to this population.”  

The pharmacy team is also highly engaged with the patients, creating a full service “high-touch” approach ensuring patients know how to take their medications, when to refill them, and whom to talk with if they need additional information, according to Guptail.

“Many individuals with mental illnesses face challenges and barriers with regards to staying on their treatment regimen, including transportation issues, cognitive impairment, undesirable side effects of medications, and financial constraints,” says study coauthor Melissa Odorzynski, PharmD, MPH, vice president, marketing and strategy at Genoa, a QoL Healthcare Compa.

Next: The Genoa model

“The Genoa model is focused on identifying reasons for non-adherence to medications, and addressing those individually, with services such as personalized counseling and refill reminder calls, delivery of medications, and specialized packaging designed to make it easier to keep track of complex medication regiments," Odorzynski says. "Most importantly, this model of care builds trust with the patients we serve and creates a welcoming, supportive environment for them.”

Working with pharmacy networks dedicated to serving mental health and other complex populations can demonstrate significant improvements in medication adherence, which will lower overall healthcare costs particularly by reducing the risk for hospitalizations and emergency department utilization, according to Odorzynski.

“Individuals with severe and persistent mental illness represent a significant and growing percentage of the population being served by Medicaid managed care plans, Medicare Advantage Special Needs Plans and Medicaid and Medicare integrated plans,” Guptail says.

Establishing and partnering with care delivery networks that include community mental health centers with integrated on-site pharmacies will produce significant savings to health plans when they can engage their members in care provided by this model, Gurptail adds.

“Measuring and evaluating pharmacy services based on the overall healthcare cost savings for individuals being served by these integrated pharmacies will provide opportunities to shift into value-based reimbursement,” he says. “This allows for improved alignment with state Medicaid managed care quality programs, Star measure performance and other quality- and value-based initiatives within managed care.”